Healthcare Provider Details

I. General information

NPI: 1427209246
Provider Name (Legal Business Name): CANYON FERRY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N FRONT ST
TOWNSEND MT
59644-2002
US

IV. Provider business mailing address

510 N FRONT ST
TOWNSEND MT
59644-2002
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-9945
  • Fax: 406-266-9945
Mailing address:
  • Phone: 406-266-9945
  • Fax: 406-266-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1414
License Number StateMT

VIII. Authorized Official

Name: WANDA LAMBOTT
Title or Position: PRESIDENT
Credential: PT
Phone: 406-266-9945